血浆高密度脂蛋白水平对慢性阻塞性肺疾病相关肺动脉高压发病风险的预测价值

Predictive value of plasma HDL-C level for risk of pulmonary hypertension in patients with chronic obstructive pulmonary disease

关键词:  慢性阻塞性肺疾病相关肺动脉高压  高密度脂蛋白  发病风险

Key words:  chronic obstructive pulmonary disease associated pulmonary hypertension  high density lipoprotein cholesterol  risk

摘要:

目的 探究慢性阻塞性肺疾病相关肺动脉高压（chronic obstructive pulmonary disease associated pulmonary hypertension, COPD-PH）患者血浆中高密度脂蛋白胆固醇（high density lipoprotein cholesterol, HDL-C）对发病风险的预测价值。 方法 回顾性纳入2019年1月—2019年8月同济大学附属上海市肺科医院643例健康体检者（作为正常对照组）、600例慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者和339例COPD-PH患者。收集患者的人口统计学指标、血生化指标和导管数据等临床资料。通过统计分析观察HDL-C对患者发病风险的预测作用。 结果 与对照组相比，COPD-PH患者血浆的总胆固醇(total cholesterol, TC)、HDL-C、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、载脂蛋白A-I(apolipoprotein A-I, ApoA-I)的水平均降低（P<0.05）；并且男性和女性患者血浆中TC、HDL-C和ApoA-I的水平均降低（P<0.05）。ROC曲线分析发现，血浆中TC、HDL-C、LDL-C和ApoA-I能较好地区分患者与对照群体（P<0.001）。单因素和多因素Logistic回归分析经年龄、性别和BMI校正后，结果发现仅有HDL-C是独立预测COPD-PH患者发病风险增加的指标（P=0.015）。 结论 COPD-PH患者血浆中HDL-C水平显著下降，血浆HDL-C水平越低，COPD-PH的发病风险越高。

Abstract:

Objective To investigate the predictive value of plasma high-density lipoprotein(HDL) level for the risk of pulmonary hypertension(PH) in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 600 COPD patients(COPD group), 339 COPD patients with PH(COPD-PH group) and 643 subjects undergoing health check-up(control group) were enrolled in Shanghai Pulmonary Hospital from January 2019 to August 2019. The demographic indicators and blood biochemical indicators of all subjects, and catheterization findings of patients were collected. The predictive effect of plasma HDL-C level on risk of PH in COPD patients was analyzed. Results Plasma levels of TC, HDL-C, LDL-C, and ApoA-I in COPD and COPD-PH groups were significantly lower than those in healthy control group(P<0.05); while the levels in COPD-PH group were lower than those in COPD group. In COPD-PH group plasma levels of TC, HDL-C, and ApoA-I were reduced in both male and female patients(P<0.05). ROC curve analysis revealed that plasma levels of TC, HDL-C, LDL-C, and ApoA- I were able to differentiate the patient and control groups(P<0.001). Univariate and multivariate Logistic regression analyses revealed that HDL-C was an independent predictor of developing COPD-PH(P=0.015). Conclusion Plasma HDL-C levels are significantly decreased in COPD-PH patients, which indicates the increased risk of COPD-PH.